This is an English translation of my op-ed « Avant d’envoyer une facture aux médecins spécialistes ». Note that this translation was generated using ChatGPT and only lightly edited, so it is not as idiomatic as the original French version.
In rebuttal to Marc Tremblay’s op-ed about specialist physicians, « Votre profession, c’est à nous que vous la devez », published on March 30, 2023
Marc Tremblay argues that Quebec doctors have a debt to Quebec society due to the public funding of their education and that they are part of the problem in the healthcare system. His letter will certainly have offended many doctors because of his proposal to send a bill to specialists to remind them of the cost of their training. By focusing entirely on the state’s contribution, the author does not recognize any agency for the individuals who underwent such lengthy studies. I propose to instead increase the number of medical students to address some of the problems raised by Mr. Tremblay.
Where Mr. Tremblay aligns more with the majority of Quebecers is in lamenting that doctors have been able, in past negotiations, to use the threat of leaving Quebec to extract concessions. But if the doctors’ threat to leave Quebec carries so much weight, it is mainly due to the shortfall in staffing created by any departure. This would be true even if doctors had borne the full cost of their training.
Moreover, requiring doctors to repay their training if they leave Quebec, as Mr. Tremblay suggests, could prompt some to do so, feeling undervalued. We would be no better off.
If Mr. Tremblay wants to reduce, in the long run, the power of doctors to threaten to leave Quebec, he should instead look at medical school admissions. Just a few years ago, the then Minister of Health, Gaétan Barrette, cut the number of medical school admissions, fearing to train “unemployed doctors.” In general, the government claims to base itself on models of medical staffing needs to determine the number of medical school seats, supposedly making the issue purely actuarial.
But it is fallacious to estimate the required staffing levels and think that we should train exactly that number of doctors. The estimate is necessarily imprecise, and the impact of an estimation error is asymmetrical. When we train too few doctors, the population lacks services, and doctors are overwhelmed. If we trained “too many,” the workload could be better distributed among doctors, and the government would gain more negotiating power, which would, for example, allow them to reduce their remuneration without fear of departures. These remuneration savings could easily exceed the cost of training the “extra” doctors. And all this, without demanding repayment from anyone.
Since doctors’ unions have not always opposed increased admissions, they might appear not to diminish their negotiating power. But the shortage may have been so severe that admissions could be significantly increased before reaching the equilibrium point. My proposal goes further, by suggesting that, in the long run, we train a number of doctors beyond the minimum required staffing levels. Such a strategy would require managing residency positions compatibly.
Of course, spots in classrooms and clinical rotations in hospitals cannot be created overnight. But given the reduction in the number of spots in the past, it is clear that we have not always trained as many doctors as was possible. Although I deplore Mr. Tremblay’s harsh tone towards our doctors, I believe it is legitimate to feel uneasy about the balance of power created by the real or perceived risk of an exodus of doctors who trained here. In the future, those who deplore the doctors’ negotiating power should suggest training more of them, rather than sending them a bill in the mail.